Medical Research Centers
24 Mar Women’s Sexual Desire May Be Sleep Dependent
MedicalResearch.com Interview with:
David A Kalmbach, PhD
Sleep and Circadian Research Laboratory
Department of Psychiatry
University of Michigan Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Kalmbach: As it happens, my research background is in sexual health, and my clinical work is in behavioral sleep medicine. Therefore, I've long been interested in the intersection between sleep and sexual response, though there has been little research in this area. With the growing recognition of a wide range of morbidities associated with poor sleep, coupled with the multifactorial etiology of sexual dysfunctions, I wanted to investigate whether sleep disturbance was associated with poorer sexual response. Using a 2-week daily diary approach in a sample of 171 young women, we found that longer reported sleep duration led to greater sexual desire the next day. This relationship was mirrored by finding that the likelihood of partnered sexual activity was increased following nights during which women slept longer. We also found an association between genital arousal and sleep length, though this relationship was more complex. Women reported greater vaginal arousal during sexual activity following nights of shorter sleep. However, women who slept longer on average reported better vaginal arousal than women who obtained less sleep on average. This dual relationship may reflect differential effects of a single night of sleep deprivations versus chronic sleep deprivation. However, I think more research is needed to delineate the underlying mechanisms of these relationships. Even so, I think it is notable that daytime sequelae of poor sleep (e.g., mood changes, fatigue) did not account for the relationships between sleep and sexual response.
23 Mar User-Generated Social Media May Reflect Hospital Quality
MedicalResearch.com Interview with:
Dr. McKinley Glover IV, MD, MHS Department of Radiology
Massachusetts General Hospital,
Harvard Medical School, Boston, MA
22 Mar Acne: Potassium Monitoring May Not Be Necessary For Spironolactone Therapy
MedicalResearch.com Interview with:
Dr. Arash Mostaghimi, MD, MPA
Director of Dermatology Inpatient Service
Brigham and Women’s Hospital
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Mostaghimi: Spironolactone, a generic drug that’s been used in the clinic since 1959, is commonly prescribed for treating hormonal acne – acne that tends to affect the jaw line most commonly around the time of the month when a woman gets her period. The US Food and Drug Administration recommends frequent potassium monitoring in patients with heart failure who are taking spironolactone as a diuretic and antihypertensive treatment, but it’s been unclear if these guidelines should apply to healthy patients taking spironolactone for the treatment of acne, and, if so, how frequently such patients should have their potassium levels tested.
My colleagues and I have found that for young, healthy women taking spironolactone to treat hormonal acne, potassium monitoring is an unnecessary health care expense. For the approximately 1,000 patients we studied, blood tests to monitor potassium levels did not change the course of treatment, but the tests cumulatively totaled up to $80,000. We suggest that routine potassium monitoring should no longer be recommended for this patient population in order to improve the patient care experience, decrease unnecessary office visits and reduce health care spending.
22 Mar Diet Soda Linked To Increased Belly Fat and Waist Size
MedicalResearch.com Interview with:
Helen P. Hazuda, Ph.D.
Professor of Medicine
Division of Nephrology
Department of Medicine
University of Texas Health Science Center
at San Antonio San Antonio, TX
Medical Research: What is the background for this study? What are the main findings?
Dr. Hazuda: The long-term effects of diet soda consumption on health outcomes is unclear, and studies in both humans and animals have raised concerns about their potentially harmful health effects including weight gain and increased cardiometabolic risk. Most human studies have focused on middle-aged or younger adults, rather than focusing specifically on people 65 years and older, a rapidly growing segment of the U.S. population that has a disproportionately high burden of cardiometabolic disease and associated healthcare costs. Therefore, our study examined prospectively the association between diet soda intake and long-term change in waist circumference in a biethnic cohort of older (65+ years) Mexican American and European American participants in the San Antonio Longitudinal Study of Aging (SALSA).
SALSA included a baseline examination (1992 – 1996) and three follow-up examinations (2000-2001, 2001-2003, and 2003-2004). The total follow-up period averaged 9.4 years. Diet soda intake, waist circumference (WC), height and weight were measured at each examination along with sociodemographic factors, leisure physical activity, diabetes mellitus, smoking, and length of follow-up.
The main finding is that over the total 9.4-year SALSA follow-up period and after adjustment for multiple potential confounders, daily diet soda users (1+ diet sodas/day) experienced an increase in waist circumference of 3.2 inches, while occasional diet soda users (>.05 < 1 diet soda/day) experienced a waist circumference increase of 1.8 inches, and nonusers of diet soda experienced a WC increase of 0.8 inches. Thus, there was a striking dose-response relationship between chronic diet soda intake and long-term increases in waist circumference.
21 Mar More Neurosurgeons Will Be Needed As Population Ages
MedicalResearch.com Interview with:
Uzma Samadani, MD, PhD
Chief of Neurosurgery, New York Harbor Health Care System
Assistant Professor, Departments of Neurosurgery, Psychiatry, Neuroscience and Physiology
Co-Director, Steven and Alexandra Cohen Veterans Center
NYU Langone Medical Center
Medical Research: What is the background for this study? What are the main findings?
Response: The purpose of this study was to determine the current and future incidence of chronic subdural hemorrhage in the United States civilian and Veterans' Administration populations. It's main findings are that, as the population ages, the incidence of subdural hemorrhage is increasing.
20 Mar Both Stenting and Bypass Surgery Reasonable For 2+ Blocked Coronary Arteries
MedicalResearch.com Interview with:
Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI
Director of Research, Cardiac Catheterization Laboratory,
Director, Cardiovascular Outcomes Group,
Associate Professor of Medicine,
New York University School of Medicine,
New York, NY 10016
Medical Research: What is the background for this study? What are the main findings?
Dr. Bangalore: Prior studies have shown a mortality benefit of bypass surgery over stenting. But these studies compared bypass surgery with older generation stents which are no longer used. We used data from the New York state registry of patients who underwent stenting or bypass surgery for 2 or more blockages of coronary arteries. With data from over 18,000 patients we found that there was no difference between stenting and bypass surgery for long term mortality. In addition we found that both procedures have trade offs. Bypass surgery has upfront risk of death and stroke whereas PCI has long term risk of needing a repeat procedure. In addition, in patients who underwent incomplete revascularization, there was increase in myocardial infarction with PCI.
20 Mar Despite High Risk Of Stroke, Some Atrial Fibrillation Patients Not Adequately Anticoagulated
MedicalResearch.com Interview with:
Jonathan L. Halperin, M.D.
The Robert and Harriet Heilbrunn Professor of Medicine
Mount Sinai School of Medicine
Dr. Halperin is a member of the Steering Committee for the GLORIA-AF program and a consultant to Boehringer Ingelheim, which sponsored this research.
Medical Research: What is the background for this study? What are the main findings?
Dr. Halperin: The two analyses come from the GLORIA-AF Registry Program, a global, prospective, observational study supported by Boehringer Ingelheim, which is designed to characterize the population of newly diagnosed patients with non-valvular atrial fibrillation (NVAF) at risk for stroke, and to study patterns, predictors and outcomes of different treatment regimens for stroke risk reduction in non-valvular atrial fibrillation patients. The data is based on treatment trends in 3,415 patients who entered the registry from November 2011 to February 2014 in North America. All patients had a recent diagnosis of NVAF, and 86.2 percent had a CHA2DS2-VASc score of 2 or higher.
Results from the first analysis demonstrated that patients with the paroxysmal (occasional) form of non-valvular atrial fibrillation and at a high risk for stroke (CHA2DS2-VASc score of 2 or higher) were given an anticoagulant medication less often than those with persistent or permanent forms of NVAF, and a CHA2DS2-VASc score of 2 or higher. This pattern runs counter to NVAF guidelines calling for patients to receive oral anticoagulant therapy based on their risk of stroke, rather than the type of atrial fibrillation.
In the second analysis, researchers found that despite high stroke risk, a considerable number of patients receive only aspirin or no medication.
20 Mar Low Dose Seizure Medication May Benefit Early Alzheimer’s Disease
MedicalResearch.com Interview with:
Arnold Bakker, Ph.D. Assistant Professor
Division of Psychiatric Neuroimaging
Department of Psychiatry and Behavioral Sciences
The Johns Hopkins University School of Medicine
Baltimore, MD 21287
Medical Research: What is the background for this study? What are the main findings?
Dr. Bakker: Patients who are at increased risk for developing dementia due to Alzheimer’s disease show hyperactivity in an area of the brain called the hippocampus, which is critically important for memory function. This study investigated the functional significance of this hyperactivity and determined if, similar to animal studies, treatment with low dose levetiracetam would reduce this increased activation and improve memory function in these patients. Results showed that this overactivity is a dysfunctional condition that contributes to the memory impairment such that treatment with very low doses of levetiracetam both reduces this overactivity and improves memory function in these patients.
20 Mar Rate At Which Genetic Code Read May Offer New Drug Targets
MedicalResearch.com Interview with:
Jeff Coller, PhD Associate professor
Division of General Medical Science
Associate director, The Center for RNA Molecular Biology,
Case Western Reserve University School of Medicine
MedicalResearch: What is the background of this study?
Dr. Coller: There are a diverse number of half-lives for any individual messenger RNA (mRNA). The range of those half-lives is from seconds to hours. What the field has wanted to know for 30 years is how those rates are regulated, and there has been considerable anecdotal and real evidence that sequences in untranslated regions (UTRs) could regulate decay, but it doesn’t explain all of the half-lives that are observed for all messages. In addition, we have known mRNAs that are translated better are more stable than mRNAs that are translated poorly, so those pieces together led to the discovery.
19 Mar Melanoma: Targeting Macrophages Increases BRAF Inhibitors’ Effectiveness
MedicalResearch.com Interview with:
Russel E. Kaufman, MD President Emeritus
Professor, Molecular and Cellular Oncogenesis Program
Molecular and Cellular Oncogenesis Program
The Wistar Institute
Medical Research: What is the background for this study? What are the main findings?
Response: Targeted therapies in cancer were hailed as a “magic bullet” because of their ability to act upon the mutations responsible for cancer while leaving nearby healthy cells alone. Using an approach like this, it would make sense that therapies designed to target mutations of BRAFV600E/K could be effective for melanoma, since that gene is mutated in about half of all cases of the disease.
However, we’ve learned over time that these targeted therapies simply aren’t as effective as we had hoped they would be. In the case of these BRAF inhibitors, while patients do live slightly longer, they eventually relapse within months of treatment. We wanted to know why this was happening.
We decided to look at macrophages, which are the most abundant inflammatory cells in melanoma. The more macrophages present in a patient with melanoma, the worse his or her outcome will be. They’ve been linked to cancer progression, but before this study, no one had really looked at the role they may play in the resistance to treatment with BRAF inhibitors.
We found that BRAF inhibitors activate the mitogen-activated protein kinase (MAPK) pathway in macrophages. When this pathway is activated, it leads to the production of vascular endothelial growth factor (VEGF), a signaling protein closely associated with angiogenesis. The VEGF produced in the macrophages is able to activate the MAPK pathway in melanoma cells, thereby stimulating the growth of cancer cells.
Taking these findings one step further, we discovered that when we blocked the MAPK pathway or VEGF signaling, we appeared to reverse macrophage-mediated resistance. When we targeted macrophages, we were able to increase the antitumor activity of BRAF inhibitors in mouse and human models.
19 Mar Healthy Diet and Physical Activity Vital For Cardiovascular Health of Kids
Posted at 18:25h
in AHA Journals, Author Interviews, Heart Disease, Pediatrics, University of Michigan
MedicalResearch.com Interview with:
Donald M Lloyd-Jones, MD/ScM
Senior Associate Dean for Clinical and Translational Research, Chair, Department of Preventive Medicine
Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS) Eileen M. Foell Professor
Professor in Preventive Medicine-Epidemiology and Medicine-Cardiology
Northwestern University Feinberg School of Medicine
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Lloyd-Jones: Previous studies have examined the associations of cardiovascular health, as defined by the American Heart Association, with outcomes in younger and middle-aged adults. Prior studies have also examined the status (i.e., prevalence) of cardiovascular health in adults across the age spectrum, and in adolescents ages 12-19 years. However, no study to date has examined the status of cardiovascular health in children under 12 years of age, so we sought to define it in detail using nationally-representative data.
Overall, although we have inadequate surveillance systems to monitor cardiovascular health optimally in our youngest children, this study shows that there are concerning signals that they are losing the intrinsic cardiovascular health they are born with, even well before age 12 years. The implications for loss of cardiovascular health before adulthood have been well established, with earlier onset of cardiovascular diseases, cancer and other diseases, earlier mortality, lower quality of life and many other adverse consequences.
18 Mar Antipsychotic Medications Linked To Higher Mortality In Dementia Patients
MedicalResearch.com Interview with:
Donovan Maust, MD, MS
Assistant Professor of Psychiatry
University of Michigan
Research Scientist, Center for Clinical Management Research
VA Ann Arbor Healthcare System
Medical Research: What is the background for this study? What are the main findings?
Dr. Maust: From a recent government report, we known that about 1/3 of older adults with dementia in nursing homes and about 14% of those in the community have been prescribed an antipsychotic. While providers focus on what benefit the treatment they offer, it is important to also be aware of the potential harms, particularly when it is death. Prior estimates came from relatively short studies and showed a 1% increase. This paper finds that, over 180 days, the increased mortality comparing antipsychotic users to matched non-users is about 2 to 5 times higher.
18 Mar Clinicians’ Race and Social Biases Did Not Affect Patient Clinical Care
Posted at 16:36h
in Author Interviews, Brigham & Women's - Harvard, JAMA, Race/Ethnic Diversity, Surgical Research
MedicalResearch.com Interview with:
Dr. Adil Haider, MD, MPH
Kessler Director of the Center for Surgery and Public Health (CSPH)
at Brigham and Women’s Hospital
Medical Research: What is the background for this study?
Response: Disparities in the quality of care received by minority and low-income patients have been reported for years across multiple medical conditions, types of care, and institutions.
To determine whether clinicians’ unconscious race and/or social class biases correlated with a lower quality of care for minority patients and those of lower socioeconomic status, my colleagues and I conducted a web-based survey among 215 physicians at an academic, level one trauma center. Participants were asked to review eight clinical vignettes, and then respond to three questions about management of care after each. Following their response, a test known as an Implicit Association Test (IAT Test) was used to assess any unconscious preferences.
Medical Research: What are the main findings?
Response: We found that race and class biases, as measured by response time to a standardized Implicit Association Test, had no relationship to the way that patients were clinically treated.
Whether the lack of association found between implicit bias and decision making in this study represents a true lack of association or the failure of clinical vignettes to capture the nuances of how implicit biases translate into management decisions remains unclear. Existing biases might influence the quality of care received by minority patients and those of lower socioeconomic status in real-life clinical encounters.
17 Mar Targeted Program Reduced Superbugs and Infections In Nursing Home Residents
MedicalResearch.com Interview with:
Lona Mody, MBBS, MSc
Associate Division Chief, Clinical and Translational Research
Associate Director, Clinical Programs, VA GRECC
Associate Professor, Internal Medicine
Research Associate Professor, Institute of Gerontology
University of Michigan Geriatrics Ann Arbor, MI
Medical Research: What is the background for this study? What are the main findings?
Response: Over 1.5 million residents live in 15,600 Nursing Homes in the US. The acuity of illness in this population has increased substantially in the last decade, as has the risk of acquiring new infections. Multi-drug resistant organisms, also known as MDROs, are endemic in this setting with prevalence estimates upwards of 35% and surpassing those in the hospitals. Nursing homes historically have had few infection prevention resources, which contributes to these high rates. Patients with indwelling devices such as urinary catheters and feeding tubes present an attractive habitat for these ‘superbugs’ and thus carry the added burden of device-related infections.
The authors examined the effect of a targeted infection program, or TIP, to reduce the prevalence of Multi-drug resistant organisms and new catheter or feeding tube infections among patients with indwelling devices. The TIP intervention was three-fold:
- Surveillance for infections and Multi-drug resistant organism colonization with regular feedback to facilities;
- Extensive and interactive staff education using adult learning theory about key infection prevention practices and hand hygiene; and
- Use of gowns and gown when providing assistance to patients for high-risk activities such as bathing and grooming.
17 Mar Public Outcomes Reporting Linked To Risk Aversion Of Sicker Patients
Posted at 20:57h
in Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Outcomes & Safety
MedicalResearch.com Interview with:
Stephen W. Waldo, MD
Research Fellow in Medicine
Massachusetts General Hospital
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Waldo: Public reporting is intended to improve outcomes for our patients. Proponents of public reporting applaud the increased transparency that it offers, allowing both patients and physicians to objectively evaluate health care outcomes for a given institution or individual provider. Previous research has demonstrated, however, that public reporting of procedural outcomes may create disincentives to provide percutaneous coronary intervention for critically ill patients. The present study sought to evaluate the association between public reporting of outcomes with procedural management and clinical outcomes among patients with acute myocardial infarction. As the data demonstrate, public reporting of outcomes is associated with a lower rate of percutaneous revascularization and increased overall in-hospital mortality among patients with an acute myocardial infarction, particularly among those that do not receive percutaneous intervention. This may reflect risk aversion among physicians in states that participate in public reporting, an unintended consequence of this policy.
17 Mar Pre-Hospital Delay Influences Sex Differences in Acute Coronary Care
Posted at 20:32h
in Author Interviews, Gender Differences, Heart Disease, UCSD, Women's Heart Health
MedicalResearch.com Interview with:
Raffaele Bugiardini, M.D.
Professor of Cardiology
University of Bologna
Medical Research: What is the background for this study? What are the main findings?
Dr. Bugiardini: Our analysis differs from previous reports of outcomes following STEMI because prior studies have not looked at sex differences in outcomes adjusted for time from symptom onset to hospital presentation and subsequent utilization of cardiac revascularization procedures, and rates of revascularization are typically significantly lower in women compared with men
Our study is the first to look at the relationship between delays and outcomes.
17 Mar New Oral Hepatitis C Virus Treatment Works But Will Cost Billions
Posted at 20:07h
in Annals Internal Medicine, Author Interviews, Hepatitis - Liver Disease, MD Anderson
MedicalResearch.com Interview with:
Jagpreet Chhatwal Ph.D.
Assistant Professor, Department of Health Services Research
Division of Cancer Prevention and Population Sciences
The University of Texas MD Anderson Center
Houston, TX
Medical Research: What is the background for this study? What are the main findings?
Dr. Chhatwal: More than two million people in the U.S. are infected with Hepatitis C (HCV), a virus found in the liver. In 2012, the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force both recommended a one-time hepatitis C screening for baby boomers – people born between the years 1946 and 1964. Last year, the Food and Drug Administration approved the medications sofosbuvir and ledipasvir for Hepatitis C treatment. The newly approved oral regimen comes at a staggering price to payers – as much as $1,125 per day. As a result, several payers have questioned if the price is justified.
The study results show that using new therapies is cost-effective in the majority of patients. However, the budget required to treat all eligible patients would be $136 billion over the next five years. Compared with the old drugs, new therapies would cost an additional $65 billion, whereas the cost offsets would be only $16 billion.
17 Mar Dark Chocolate May Improve Exercise Capacity and Metabolic Parameters
Posted at 11:15h
in Author Interviews, Chocolate, Exercise - Fitness, Heart Disease, JACC, UCLA, UCSD
MedicalResearch.com Interview with:
Pam R. Taub, MD, FACC
Assistant Professor of Medicine
UC San Diego Health System
Division of Cardiology Encinitas, CA 92024
Medical Research: What is the background for this study?
Dr. Taub: Epidemiological studies indicate that the consumption of modest amounts of dark chocolate (DC), which contains the natural cacao flavanol (-)-epicatechin (Epi,) is associated with reductions in the incidence of cardiovascular diseases (CVD). The health benefits of dark chocolate have been attributed to Epi. Clinical studies using cocoa and/or DC in normal volunteers or subjects with CVD have reported improvements in peripheral and coronary vascular endothelial function, blood pressure, lipids, insulin resistance, and inflammatory markers. The mechanism underlying these improvements is thought to be due to increased nitric oxide levels and improved endothelial function. We have also shown that capacity of Epi to favorable impact mitochondria under normal and disease states.
We previously conducted pilot study in five patients with heart failure and type II diabetes, and showed that in skeletal muscle (SkM) biopsies there is a severe reduction in mitochondrial volume and cristae, as well as, in structural/functional proteins. After treatment with Epi rich dark chocolate , there was a significant recovery of SkM mitochondrial cristae, structural/functional proteins (e.g. mitofilin), as well as in regulators of mitochondrial biogenesis. However, no studies have examined the capacity of Epi rich dark chocolate to enhance exercise capacity in normal subjects and assess its impact on mitochondrial and oxidative control systems.
Medical Research: What are the main findings?
Dr. Taub: Seventeen subjects were randomized to placebo (n=8) or DC groups (n=9) and consumed 2 squares of chocolate (20 g, provided by Hershey) for 3 months.
We showed in the chocolate group subjects had improved levels of HDL cholesterol and enhanced exercise capacity that is linked to the stimulation of SkM metabolic control endpoints which enhance mitochondrial function.
16 Mar Sodium Content In Commercial Foods Remains High and Variable
MedicalResearch.com Interview with: Jaspreet Ahuja, Nutritionist
USDA, Agricultural Research Service
Nutrient Data Laboratory
Beltsville, MD 20705
MedicalResearch: What is the background for this study? What are the main findings?
Response: Most sodium in the U.S. diet comes from commercially processed and restaurant foods. Sodium reduction in these foods is key to several recent public health efforts. In this paper, we provide an overview of a program led by Nutrient Data Laboratory, USDA, in partnership with CDC and FDA to monitor sodium contents in commercially processed and restaurant foods in United States.
We track about 125 highly consumed, sodium-contributing foods, termed “Sentinel Foods” annually using information from food manufacturers and periodically by nationwide sampling and laboratory analyses. In addition, we monitor over 1,100 other commercially processed and restaurant food items, termed “Priority-2 Foods,” biennially using information from food manufacturers. These foods serve as indicators for assessing changes in the sodium content of commercially processed and restaurant foods in the U.S. In addition to sodium, we are monitoring related nutrients (potassium, total dietary fiber, total and saturated fat, total sugar) because their levels may change when manufacturers and restaurants reformulate their products to reduce their sodium content.
We sampled all Sentinel Foods nationwide and reviewed all Priority-2 Foods in 2010–2013 to determine baseline sodium concentrations. The results of sodium reduction efforts, based on re-sampling of the Sentinel Foods or re-review of P2Fs, will become available in 2015 on our website. The updated data are also released in USDA food composition databases, National Nutrient Database for Standard Reference and Food and Nutrient Database for Dietary Studies.
15 Mar TAVR Bests Standard Therapy For Sick, Elderly Patients With Severe AS
Prof Samir R Kapadia MD Director, Sones Cardiac Catheterization Laboratories Cleveland Clinic Cleveland, OH For patients with severe symptomatic aortic stenosis (AS) who are not candidates for surgical valve replacement, transcatheter aortic valve replacement (TAVR) offers superior benefit to standard therapy, as measured by all-cause mortality, cardiovascular mortality, repeat hospital admission and functional status. PARTNER 1B 5 year data were published simultaneously with PARTNER 1A 5 year data in 2 separate manuscripts in the Lancet (March 15 2105). In this landmark trial, TAVR produced a 22 percent survival benefit and a 28 percent reduced risk of cardiovascular mortality, compared with standard treatment. According to Cleveland Clinic interventional cardiologist Samir Kapadia, MD, lead author of PARTNER 1B, these findings have changed the treatment paradigm for severe Aortic Stenosis patients who can’t undergo surgical Aortic Valve Replacement. “This trial is the first—and will probably be the only—randomized AS trial that includes a standard treatment group, since these results will make it unethical to treat severe AS patients with medical therapy alone without aortic valve replacement. ” he says. Superior survival benefit with TAVR PARTNER 1B is the only rigorous randomized trial of extreme-risk aortic stenosis patients that has prospectively reported the outcomes of TAVR versus standard treatment in patients for whom the estimated probability of death or serious irreversible morbidity after surgical aortic valve replacement was 50 percent or greater. The trial enrolled 358 patients between May 11, 2007 and March 16, 2009; 179 patients were assigned to TAVR with the first-generation Sapien valve and 179 to standard therapy which includes medical therapy and balloon aortic valvuloplasty. TAVR was performed under general anesthesia with common femoral artery access. Guidance was provided by transesophagel echocardiography and fluoroscopy. The mean age of participants was 83. The primary endpoint was all-cause survival. Secondary endpoints included cardiovascular mortality, stroke, vascular complications, major bleeding and functional status.14 Mar Hispanic and Uninsured Adults May Experience Barriers To Blood Pressure Control
Posted at 12:18h
in AHA Journals, AHRQ, Author Interviews, Blood Pressure - Hypertension, Electronic Records, NYU/NYMC
MedicalResearch.com Interview with:
Stella Yi, Ph.D., MPH, Assistant Professor
Department of Population Health
New York University School of Medicine
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Yi: Self-blood pressure monitoring has been shown to be an effective tool for improving blood pressure control, however most studies have only included white race participants. We were interested in assessing whether distribution of self-blood pressure monitors (intervention) would improve blood pressure and hypertension control over usual care (control) in a 9-month period in a predominantly Hispanic, uninsured population. Systolic blood pressure improved over time in both the intervention (n=409) and the control (n=419) arms by 14.7 mm Hg and 14.1 mm Hg, respectively, as did hypertension control; 39% of study participants overall achieved control at the end of follow-up. However there were no statistical differences between the outcomes in the intervention and usual care groups.
13 Mar Majority of Women Experience Stressful Life Events In Year Before Giving Birth
MedicalResearch.com Interview with: Elizabeth Burns, MPH Rollins School of Public Health Emory University MedicalResearch: What is the background for this study? What are the main findings? Response: Epidemiologic studies suggest that prenatal stress is associated with preterm birth, low birth weight and peripartum anxiety and depressive symptoms. The most recent population-based study on the prevalence of stress among pregnant women, which used data from 1990-1995, reported that 64% of women experience stressful life events (SLEs) in the year before their infant’s birth. More recent estimates of prevalence and trends of prenatal stressful life events are useful for clinicians in order to understand the risk profile of their patients. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects self-reported information on maternal experiences and behaviors before, during, and after pregnancy among women who delivered a live infant. PRAMS includes 13 questions about maternal SLEs experienced in the year preceding the birth of the child. Based on previous research, SLEs were grouped into four dichotomous constructs: 1) emotional stressors (family member was ill and hospitalized or someone very close died); 2) financial stressors (moved to a new address, lost job, partner lost job, or unable to pay bills); 3) partner-associated stressors (separated/divorced, argued more than usual with partner/husband, or husband/partner said he did not want pregnancy); and 4) traumatic stressors (homeless, involved in a physical fight, partner or self-went to jail, or someone very close had a problem with drinking or drugs). The prevalence of self-reported stressful life events decreased modestly but significantly during 2000–2010. Despite this, 70.2% of women reported ≥1 SLEs in 2010. Prevalence of stressful life events vary by state and maternal demographic characteristics and are especially prevalent among younger women, women with ≤12 years of education (75.6%), unmarried women (79.6%), and women that were covered by Medicaid for prenatal care or delivery of their child (78.7%).13 Mar Lifestyle Factors May Limit Cognitive Decline
MedicalResearch.com Interview with: Miia Kivipelto MD, PhD, Professor Deputy Head, Senior Geriatrician Aging Research Center and Alzheimer Disease Research Center Karolinska Institutet Clinical Trials Unit, Memory Clinic Karolinska University Hospital Stockholm, Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Kivipelto: Epidemiological studies have linked several modifiable risk factors to cognitive impairment and dementia but evidence from randomized controlled trials (RCT) has been lacking showing the efficacy of the interventions. Because cognitive impairment, dementia and Alzheimer’s disease are complex, multi-factorial disorders, multidomain interventions targeting several risk factors and disease mechanisms simultaneously could be needed for optimum preventive effect. The FINGER study is the first large, long-term RCT indicating that multi-domain intervention can improve and maintain cognitive functioning in at risk elderly people from the general population. We observed a significant intervention effects on the primary outcome (overall cognition), main secondary outcomes (executive functioning and processing speed) as well as on complex memory tasks and risk of cognitive decline. The multidomain lifestyle intervention was feasible and safe.12 Mar Inappropriate Breast, Prostate Imaging Regionally Clustered
MedicalResearch.com Interview with:
Danil Makarov, MD Lead Investigator
Assistant Professor, Departments of Urology, Population Health and Health Policy
Member, Laura and Isaac Perlmutter Cancer Center
NYU Langone Medical Center, New York, NY
Medical Research: What is the background for this study?
Dr. Makarov: The background for this study is that regional variation in patterns of care and healthcare spending is widely known. The drivers of this regional variation, though, are poorly understood. Certain policy groups like the IOM have suggested that policy efforts be focused on individual providers and patients. Programs such as Choosing Wisely, which encourage a dialogue between physicians and patients, are a great example of such efforts. However, some of our prior research suggests that regional variation is not random and that there might be are regional-level factors which drive variation.
To test out our hypothesis, we wanted to see whether inappropriate imaging for two unrelated cancers was associated at a regional level (it should not be).
Medical Research: What are the main findings?
Dr. Makarov: We found that, at a regional level, inappropriate breast cancer imaging was associated with inappropriate prostate cancer imaging.
12 Mar Pre-pregnancy BMI And Gestational Weight Gain Linked To Childhood Obesity
MedicalResearch.com Interview with: Elizabeth M. Widen, PhD, RD Postdoctoral Fellow in the Institute of Human Nutrition & Department of Epidemiology Columbia University Mailman School of Public Health New York, NY 10032 Medical Research: What is the background for this study? What are the main findings? Dr. Widen: The Columbia Center for Children’s Environmental Health Mothers and Newborns...
12 Mar NSAIDS May Be Helpful In Bladder Cancer Prevention
MedicalResearch.com Interview with: James Scheiman, M.D. Professor of Gastroenterology University of Michigan Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Scheiman: Using aspirin or other nsaids to reduce the risk of many cancers has been an active area of investigation. This study demonstrates in an...
12 Mar Epigenetics, Not Just Genes, Control Many Complex Traits
MedicalResearch.com Interview with:
Prof. Moshe Szyf Ph.D.
James McGill Professor of Pharmacology and Therapeutics
McGill University
Medical Research: What is the background for this study? What are the main findings?
Dr. Szyf: Humans exhibit a marked variation in traits both physical and behavioral and different susceptibilities for developing disease. What causes this inter-individual variation? The prevailing dogma has been that changes in the sequences of genes or heritable genetic differences are responsible for these differences. We tested here an alternative hypothesis that perhaps some of the reason for this natural variation in traits is not caused by differences in inherited genes but by “epigenetic” changes that alter the way genes work without changing the genes. The main difference between genetic and epigenetic changes is that epigenetic changes could be introduced by experience and exposure to environment. The experiences that can cause epigenetic changes include physical as well as social environments. Although we had known that epigenetic differences occur in humans and animals we didn’t have evidence that these changes are behind the natural variation in traits that is observed in humans and animals. Ants are an exciting biological paradigm that exhibits quantitative variations in size and therefore provided a unique opportunity to test this hypothesis.
11 Mar ‘Leadership Saves Lives’ Program Aims To Reduce Heart Attack Mortality
MedicalResearch.com Interview with:
Leslie Curry PhD, MPH
Senior Research Scientist in and Lecturer in Public Health (Health Policy)
Co-Director, Robert Wood Johnson Clinical Scholars Program
Yale School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Curry: Quality of care for patients with acute myocardial infarction (AMI) has improved substantially in recent years due to important investments by clinicians and policymakers; however, survival rates across U.S. Hospitals still differ greatly. Evidence suggests links between hospital organizational culture and hospital performance in care of patients with AMI. Yet few studies have attempted to shift organizational culture in order to improve performance, fewer have focused on patient outcomes, and none have addressed mortality for patients with acute myocardial infarction. We sought to address this gap through a novel longitudinal intervention study, Leadership Saves Lives (LSL). We have a large team of people with backgrounds in nursing, medicine, health care administration and research working in 10 very diverse hospitals across the country in 10 states. All hospitals are members of the Mayo Clinic Care Network and are fully committed to saving lives of patients with heart attacks. Teams of 10-12 clinicians and administrators are devoting substantial energy, expertise and good will to this project.
11 Mar Inhaled Nitric Oxide Still Used Off-Label In Preterm Infants
Posted at 12:01h
in Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Mayo Clinic, Outcomes & Safety, Pediatrics, Pediatrics
MedicalResearch.com Interview with:
Marc Ellsworth, M.D
Neonatology fellow at the
Mayo Clinic Children’s Center
MedicalResearch: What is the background for this study?
Dr. Ellsworth: Inhaled Nitric Oxide (iNO) is a drug that has FDA approval for use in neonates >34 weeks gestational age. It is used for severe respiratory failure secondary to pulmonary hypertension. However, it has been previously shown that neonatologists have been using this medication off-label and especially in the most premature neonates. Over the last 10 years there have been multiple large studies trying to determine a clinical use (ie long term benefit) for iNO in preterm neonates (patients where there is no FDA approval for iNO use currently). Despite evidence of short term benefit (improved clinical stability) use of this drug has not been shown to improve long-term outcomes (death and chronic lung disease) in premature neonates. As a result of these findings the National Institute of Child Health and Human Development (NICHD) released a consensus guideline in 2011 indicated that available evidence did not support the routine use of iNO in preterm neonates and discouraged this use of this expensive therapy in preterm neonates. Similarly, in 2014 the American Academy of Pediatrics issued a similar statement with similar recommendations.
In 2014 a group of NICUs (collectively called the Neonatal Research Network) associated with the NICHD published a report showing that the use of Inhaled Nitric Oxide in preterm infants (ie off-label) decreased following the report in 2011.
However, I did not feel that these NICUs were representative of the United States alone as the Neonatal Research Network consists of only a handful of NICUs (~15) and is directly associated with the NICHD. As a result I wanted to get a better idea of Inhaled Nitric Oxide use in a population based study to see if the trends were similar (ie use of iNO has been decreasing) on a much larger, more representative scale. (Editorial comment: My anecdotal experience was that rates of iNO use off-label have not decreased in preterm neonates since the 2011 report).